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General NPI Number Information
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NPI Number | 1962143180
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Entity Type | Individual
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Provider Name | KYLIE NELSON
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Gender | Female
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Dates
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Enumeration Date | 04/03/2022
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 3521 RICHLAND AVE
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City | AIKEN
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State | SC
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Zip | 29801-6311
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Country | US
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Telephone | 836-414-4646
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Fax | 803-641-4648
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Provider Business Mailing Address
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Address Line | 3521 RICHLAND AVE
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City | AIKEN
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State | SC
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Zip | 29801-6311
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Country | US
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Telephone | 836-414-4646
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Fax | 803-641-4648
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2022026133
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2509
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License Number State | SC
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